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Purpose of the study: Macrolide therapy is effective in reducing chronic obstructive pulmonary disease (COPD) exacerbations. Our recent study has shown the effectiveness of taking azithromycin in COPD patients, not only ex-smokers but also current smokers. Beyond their anti-microbial effects, macrolides have anti-inflammatory and immunomodulatory properties. The aim of this study was to determine if pretreatment with azithromycin modulates cigarette smoke-induced inflammation in airway epithelial cells. We hypothesized that pretreatment with azithromycin decreases exacerbation frequency by modulating inflammation in human airway epithelial cells exposed to cigarette smoke. Materials and methods: BEAS-2B bronchial epithelial cells were incubated with 5% cigarette smoke extract (CSE) for 3 h, 6 h, and 24 h. Then, airway epithelial cells were pretreated with azithromycin and exposed to 5% CSE. In each stage, the expression and release of IL-6 and IL-8 mRNA were analyzed by quantitative real-time PCR (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. Results: There was a significant increase of IL-6 and IL-8 mRNA, as well as an increase in extracellular IL-8 protein following exposure to 5% CSE. When cells were pretreated with azithromycin and exposed to 5% CSE for 3 h, there was a significant dose-dependent decrease in the expression of IL-6 mRNA. A final concentration of 9 µg/mL of azithromycin was sufficient to decrease IL-6, IL-8 mRNA, and extracellular IL-8 levels. Conclusion: Pretreatment with azithromycin decreased the expression of IL-6 and IL-8 mRNA and the release of IL-8 in bronchial epithelial cells exposed to cigarette smoke. These results demonstrate the direct effect of azithromycin on inflammatory mediators in bronchial epithelial cells exposed to cigarette smoke.
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Azitromicina , Doença Pulmonar Obstrutiva Crônica , Azitromicina/farmacologia , Brônquios , Células Epiteliais , Humanos , Mediadores da Inflamação , Fumaça/efeitos adversos , FumarRESUMO
We studied whether fractional exhaled nitric oxide (FENO) can differentiate chronic obstructive pulmonary disease (COPD) with concurrent diagnosis of asthma from COPD-only as well as its ability to predict disease severity and progression. This study was embedded in the Canadian Cohort Obstructive Lung Disease (CanCOLD). Subjects of ≥40 years old completed FENO measurements were subdivided into four groups, including COPD (N = 86 [COPD-only (N = 35) and COPD with concurrent diagnosis of asthma (N = 51)], healthy (N = 72), and at risk (N = 151). Three of the most common clinical definitions were used for characterizing COPD with concurrent diagnosis of asthma: 1) atopy and self-reported physician diagnosis of asthma, 2) ≥12% and ≥200 ml post-bronchodilator FEV1; 3) self-reported physician diagnosis of asthma. FENO values were classified using quartiles and the American Thoracic Society (ATS) guideline 2011. Compared to COPD-only, more COPD with concurrent diagnosis of asthma had a significant FENO50 level of [Formula: see text] 33.5 ppb (fourth quartile) than COPD-only (p = 0.045, 0.011, and 0.006, for definition 1, 2, and 3, respectively). Considering the ATS guideline 2011, fewer COPD with concurrent diagnosis of asthma had FENO50 < 25 than COPD-only, which was statistically significant with definition 1 and 3 (p = 0.038 and 0.026, respectively). FENO as a biomarker has the potential to be used as a complementary value for differentiating COPD with concurrent diagnosis of asthma from COPD-only. Further studies should be conducted on validated definitions of COPD with concurrent diagnosis of asthma, which may include a reference to the type of airway inflammation in addition to the clinical definition.
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Asma/diagnóstico , Asma/metabolismo , Expiração , Óxido Nítrico/metabolismo , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/complicações , Biomarcadores/metabolismo , Testes Respiratórios , Canadá , Estudos de Coortes , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/complicações , Índice de Gravidade de DoençaRESUMO
Chronic obstructive pulmonary disease (COPD) is the most common fixed airflow limitation. Individuals may present with the features of both asthma and COPD called asthma-COPD overlap (ACO) with more severity and worse health-related quality of life than COPD or asthma. One of the promising biomarkers that could be used in clinical practice to differentiate ACO from COPD is fractional exhaled nitric oxide (FENO). The role of Fractional exhaled nitric oxide (FENO) in COPD/ACO remains unknown. This scoping review aims to investigate the role of FENO measurement to differentiate COPD from ACO, to anticipate disease severity/progression and treatment response. A structured comprehensive literature search was performed in major databases including Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and BIOSIS from 2005 onwards. Thirty-eight studies were retrieved. Based on the synthesis of the reviewed literature, six themes emerged. Thirty-four articles covered more than one theme. From which, 24 articles were on modifying factors in FENO measurement, 18 on FENO in COPD compared with healthy subjects, and seven on FENO in ACO compared with COPD, 22 on FENO and disease severity/progression,12 on FENO and biomarkers, and eight on FENO and treatment response. FENO measurement cannot be used alone in the clinical settings of COPD patients. Although FENO level is higher in ACO patients than COPD-only, it is still unclear if there is a FENO cut-off that can be used to make the diagnosis of ACO and/or to guide therapy with inhaled corticosteroids/glucocorticoids in COPD patients.
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Asma/metabolismo , Óxido Nítrico/metabolismo , Doença Pulmonar Obstrutiva Crônica/metabolismo , Asma/complicações , Asma/tratamento farmacológico , Testes Respiratórios , Glucocorticoides/uso terapêutico , Humanos , Óxido Nítrico/análise , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológicoRESUMO
RATIONALE: According to clinical trials, azithromycin taken daily for 1 year, decreased exacerbations of chronic obstructive pulmonary disease (COPD). OBJECTIVES: Effectiveness evaluation of long-term azithromycin to reduce exacerbations in severe COPD patient on optimal therapy in real-life practice. METHODS: We conducted a retrospective observational study of severe COPD patients who were prescribed azithromycin (PA)(250â¯mg, at least 3 times weekly for at least 6 months). Comparison group included severe COPD patients not prescribed azithromycin (NPA). Data were extracted from clinical chart review. MAIN RESULTS: Study included 126â¯PA and 69 NPA patients. They had severe airflow obstruction, mostly emphysema and one-third bronchiectasis. A predominant feature in the PA group was respiratory tract colonization with Pseudomonas aeruginosa. The mean number of exacerbations per patient per year in the PA group was 3.2⯱â¯2.1 before initiating azithromycin, and 2.3⯱â¯1.6 during following year on therapy (pâ¯<â¯0.001). Patients in the NPA group had 1.7⯱â¯1.3 and 2.5⯱â¯1.7 exacerbations during first and second follow-up year respectively (pâ¯<â¯0.001). Exacerbation changes from pre to post differed between groups (pâ¯<â¯0.001). Decrease in emergency visits and hospital admissions was significant in PA group. Exacerbation reductions and patient proportions having ≥2 exacerbations extended to the second year of treatment. CONCLUSION: These data showed that long-term azithromycin reduces exacerbation numbers in severe COPD patients, and benefits persist beyond one year. Desirable effects are more likely to outweigh the risks and adverse events in patients colonized with Pseudomonas aeruginosa.
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Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Azitromicina/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Aguda , Idoso , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções Bacterianas/complicações , Infecções Bacterianas/prevenção & controle , Esquema de Medicação , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/microbiologia , Infecções Respiratórias/complicações , Infecções Respiratórias/prevenção & controle , Estudos Retrospectivos , Fumar , Escarro/microbiologiaRESUMO
INTRODUCTION: During the last decade, many articles have been published, including reviews on fractional exhaled nitric oxide (FeNO) use and utility in clinical practice and for monitoring and identifying eosinophilic airway inflammation, especially in asthma, and evaluating corticosteroid responsiveness. However, the exact role of FeNO in patients with chronic obstructive pulmonary disease (COPD) and its ability to distinguish patients with COPD and those having concomitant asthma, that is, asthma-COPD overlap (ACO) is still unclear and needs to be defined. Due to the broad topics of FeNO in chronic airway disease, we undertook a scoping review. The present article describes the protocol of a scoping review of peer-reviewed published literature specific to FeNO in COPD/ACO over the last decade. METHODS AND ANALYSIS: We used Joanna Briggs Institute Reviewers' Manual scoping review methodology as well as Levac et al's and Arksey et al's framework as guides. We searched a variety of databases, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and BioSciences Information Service (BIOSIS) on 29 June 2016. Additional studies will be recognised by exploring the reference list of identified eligible studies. Screening of eligible studies will be independently performed by two reviewers and any disagreement will be solved by the third reviewer. We will analyse the gathered data from article bibliographies and abstracts. ETHICS AND DISSEMINATION: To investigate the body of published studies regarding the role of FeNO in patients with COPD and its usefulness in the clinical setting, a scoping review can be used as a modern and pioneer model, which does not need ethics approval. By this review, new insights for conducting new research specific to FeNO in COPD/ACO population will emerge. The results of this study will be reported in the scientific meetings and conferences, which aim to provide information to the clinicians, primary care providers and basic science researchers.
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Asma/fisiopatologia , Inflamação/fisiopatologia , Óxido Nítrico/análise , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Corticosteroides/uso terapêutico , Asma/complicações , Asma/tratamento farmacológico , Biomarcadores/análise , Testes Respiratórios , Expiração , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Projetos de PesquisaRESUMO
[This corrects the article DOI: 10.5402/2012/927923.].
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Myocardial dysfunction is a major complication in cardiac surgery that needs inotropic support. This study evaluates the effect of milrinone on patients with low ventricular ejection fraction undergoing off- pump coronary artery bypass graft (OPCAB). The present study is designed to evaluate the effect of milrinone on myocardial dysfunction. Eighty patients with low ventricular ejection fraction (<35%), candidate for elective OPCAB, were enrolled in this study. They were randomly assigned to two groups. One group received milrinone (50 µg/kg) intravenously and another group received a saline as placebo followed by 24 hours infusion of each agent (0.5 µg/kg/min). Short outcome of patients such as hemodynamic parameters and left ventricular ejection fraction were variables evaluated. Serum levels of creatine phosphokinase, the MB isoenzyme of creatine kinase, occurrence of arrhythmias and mean duration of mechanical ventilation were significantly lower in milrinone group (P<0.05). The mean post operative left ventricular ejection fraction was significantly higher in milrinone group (P=0.031). There were no statistical significant differences between the two groups in terms of intra-aortic balloon pump, inotropic support requirement, myocardial ischemia, myocardial infarction, duration of inotropic support, duration of intensive care unit stay, mortality and morbidity rate. Administration of milrinone in patients undergoing OPCAB with low ventricular ejection fraction is useful and effective.
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Cardiotônicos/uso terapêutico , Ponte de Artéria Coronária , Milrinona/uso terapêutico , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/cirurgia , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , PlacebosRESUMO
BACKGROUND: Symptomatic or asymptomatic deep vein thrombosis (DVT) is a common complication following coronary artery bypass graft (CABG), in which less than 1% of these patients suffer from clinically evident pulmonary embolism (PE). DVT and PE can increase other morbidities of coronary revascularization from short to long period, but no clear consensus still exists regarding proper thromboprophylaxis strategy in the literatures. This study was designed to compare the anti-platelet prophylaxis of aspirin plus heparin with heparin alone on asymptomatic perioperative DVT in patients that are candidates for elective off-pump CABG. METHODS: One hundred and twenty patients, who are candidates for elective off-pump CABG, were randomly assigned to two groups: the aspirin plus heparin group (Group 1, n = 60) that received 80 mg daily aspirin orally and 5000 U unfractionated heparin per 8 h subcutaneously from admission to discharge time, and the heparin group (group 2, n = 60) that received same dose of heparin alone. All patients underwent right and left leg venous ultrasound examination during hospitalization, after which post-operative off-pump CABG complications such as deep vein thrombosis, bleeding and pulmonary embolism were evaluated in this study cases. RESULTS: The mean age of the patients was 62.10 ± 10.71 years with a male to female ratio of 2.24. Asymptomatic DVT occurred in 12 (10%) patients who underwent elective off-pump CABG. DVT was found more in Group 2 (16.6%) as compared to Group 1 (3.3%) with statistical significant difference (p = 0.015). Bleeding was detected in 5 (4.1%) cases in the patients sampled in this study (p = 0.34), 4 cases of which are from Group 1 and 1 case from Group 2. However, PE was shown in none of this study cases. CONCLUSIONS: The incidence of DVT decreased more with aspirin plus heparin as compared to heparin alone in patients who underwent elective off-pump CABG. As regards the results obtained in this study, more studies need to be conducted to establish this strategy for prophylaxis of DVT in CABG.
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Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Heparina/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Trombose Venosa/prevenção & controle , Idoso , Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Procedimentos Cirúrgicos Eletivos , Feminino , Heparina/efeitos adversos , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologiaRESUMO
Cardiovascular diseases are common in systemic rheumatologic diseases. They can be presented at the time of diagnosis or after diagnosis. The cardiac involvements can be the first presentation of rheumatologic conditions. It means that a patient with rheumatologic disease may go to a cardiologist when attacked by this disease at first. These manifestations are very different and involve different structures of the heart, and they can cause mortality and morbidity of patients with rheumatologic diseases. Cardiac involvements in these patients vary from subclinical to severe manifestations. They may need aggressive immunosuppressive therapy. The diagnosis of these conditions is very important for choosing the best treatment. Premature atherosclerosis and ischemic heart disease are increased in rheumatoid arthritis and systemic lupus erythematosus, and may be causes of mortality among them. The aggressive control of systemic inflammation in these diseases can reduce the risk of cardiovascular disease especially ischemic heart disease. Although aggressive treatment of primary rheumatologic diseases can decrease mortality rate and improve them, at this time, there are no specific guidelines and recommendations, to include aggressive control and prevention of traditional risk factors, for them.
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BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis (MS) is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement. MATERIALS AND METHODS: We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement (MVR) surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL (IgM, IgG), ANCA, RF were performed on participants' samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge. RESULTS: The mean age of patients was 48.56 ± 17.64 years. 57 cases (57%) were male, and 43 cases (43%) were female. Post-operative AF occurred in 14 cases (14%); 3 cases (6%) in non-rheumatic mitral stenosis group, and 11 cases (22%) in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis (P = 0.02). Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group (P = 0.026). There was no relationship between the type of mitral stenosis (rheumatic or non-rheumatic) and early mortality after mitral valve replacement (P = 0.8). CONCLUSION: We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement.
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This is a descriptive case report of a 30-year-old man with massive epistaxis, echymosis on arms, abnormal CBC and increased plasma urea and creatinine level (i.e. above normal range). Probably, these are as side effects of interferon beta-1a injection. This is the first report according to our literature search (Pub Med, Google scholar, ISI web of knowledge, ProQuest, MD consult, Science Direct, and SCOPUS) about interferon beta-1a related abnormal kidney function tests hereafter. Abnormal kidney function tests (i.e. increased plasma urea and creatinie level) is not a known as side effect of interferon beta-1a. This case indicates, likely potential for development of these side effects with this medication.
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Background and Objectives. Valvular heart diseases are among the frequent causes of cardiac surgery. Some patients have a well-known rheumatic condition. Heart valves are fragile connective tissues which are vulnerable to any systemic autoimmune diseases. This study was designed to evaluate the frequency of rheumatological background in patients candidate for valvular heart surgery in Afshar Cardiovascular Center, Yazd, Iran. Methods. One hundred and twenty (120) patients candidate for valvular heart surgery were selected for this study. Careful history and physical examination were undertaken from rheumatological stand points. The most sensitive screening serologic tests were also assayed. Results. The result of this study showed that 53.3% were male and 46.6% were female with mean age of 48.18 ± 17.65 years old. 45.8% of the patients had history of nonmechanical joint disease, 14.2% had history of rheumatological conditions in their family, and 30% had history of constitutional symptoms. 29.8% had positive joint dysfunction findings in their physical examination while 25.8% had anemia of chronic disease. Positive Rheumatoid factor (RF), anticyclic citrullinated peptide (CCP, ACPA), C-reactive protein (CRP), antinuclear antibody (ANA), abnormal urine and elevated erythrocyte sedimentation rate (ESR) were 34, 2.5, 26.7, 4.2, 5, and 36.7%, respectively. Antineutrophil cytoplasmic antibody (ANCA) and antiphospholipid (APL) were positive in a few cases. Conclusion. The findings of this study show immunologic bases for most patients with valvular heart diseases candidate for surgery. Undifferentiated connective tissue diseases may play an important role in the pathophysiology of valvular damage.